Baker Ober Health Law

Delayed ETA for EPMs – CMS Delays New Bundled Payment Models

On March 21, 2017, CMS issued the anticipated delay related to the new Episode Payment Model (EPM) bundled payment program regulations that were finalized in January. The rule, Advancing Care Coordination Through Episode Payment…more
| Health

CMS Issues Instructions to Hospitals Regarding the Implementation of Ruling 1498-R2

In April 2015, CMS issued Ruling 1498-R2 addressing the calculation of the Medicare fraction of the disproportionate share hospital (DSH) adjustment for patient discharges prior to October 1, 2004. CMS has now issued…more
| Health

Hearing Held on McCarran Repeal Legislation

On February 16, the House Judiciary Subcommittee on Regulatory Reform, Commercial and Antitrust Law held a hearing to consider H.R. 372, the "Competitive Health Insurance Reform Act of 2017." The legislation, introduced by…more
| Antitrust & Trade Regulation, Health, Insurance

DOJ Prevails in Both the Anthem and Aetna Merger Trials

During the summer of 2015, within a matter of days, Aetna announced an intention to merge with Humana and Anthem announced an intention to merge with Cigna. The deals, among the largest insurance industry combinations ever…more
| Antitrust & Trade Regulation, Mergers & Acquisitions, Health

The Trump Administration Begins the Task of Selecting New Federal Antitrust Enforcers

With every new administration, there is typically a change in the leadership of both the Federal Trade Commission and the DOJ Antitrust Division, the two regulators principally responsible for federal antitrust oversight. Not…more
| Antitrust & Trade Regulation, Elections & Politics

340B Drug Pricing Program: The Withdrawal of Mega Guidance and the Future of Patient Definition

In the wake of a recent directive issued by the Trump administration to halt pending regulations and guidance while the new leadership conducts its own review, the Department of Health and Human Services, on January 30, 2017,…more
| Health, Insurance

HHS Makes Its First Move to Stabilize the Individual Health Insurance Market

Wednesday, the Trump Administration released its first proposed regulation seeking to stabilize the individual insurance market – in particular, the Affordable Care Act (ACA) insurance exchange market (or marketplace). Amidst…more
| Elections & Politics, Health, Insurance

New Bundled Payments Are a Go…For Now

CMS issued a final rule on January 3, 2017, implementing three new episode payment models (EPMs) and a Cardiac Rehabilitation (CR) incentive payment model under the authority of the Center for Medicare & Medicaid Innovation…more
| Health

Despite Uncertain Future of ACA, OIG Issues Final Rule Revising Permissive Exclusion Authority

On January 12, 2017, the Department of Health and Human Services (HHS), Office of Inspector General (OIG) published a final rule expanding its permissive exclusion authority while also codifying certain statutory changes made by…more
| Elections & Politics, Health

SAMHSA Continues to Update Rules Related to Substance Abuse Records

On January 13, 2017, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued the Final Rule to revise 42 C.F.R. Part 2 (Part 2 Regulations) – the federal regulations that govern the confidentiality of…more
| Administrative Law, Health, Privacy

HHS Publishes Final Rule Overhauling the Medicare Appeals Process

The Department of Health and Human Services (HHS) published its final rule revamping the Medicare appeals process at the Administrative Law Judge (ALJ) level on January 17, 2017. The final rule extensively revises federal…more
| Administrative Law, Health

Avoiding Rejected Applications – Correct Form Version?

For providers and suppliers that utilize the Medicare enrollment application forms, in lieu of Internet PECOS, it is important to confirm the current version of each form prior to its completion and submission. This can be…more
| Health

CMS Finalizes Revamped Home Health Agency Conditions of Participation

CMS recently issued revamped home health agency (HHA) conditions of participation (CoPs), strengthening patient confidentiality, patient rights, quality assessment, care and performance standards. The final rule was published in…more
| Health

Medicaid: Significant Changes Coming in 2017 and Beyond

With Congress back in session, attention in the health care policy universe is directed squarely at Washington, where Republicans in Congress and the Trump Administration are debating how to repeal and replace the Affordable…more
| Elections & Politics, Health, Insurance

Final Rule Implements Quality Payment Program under MACRA

If you are a physician, mid-level provider, or work with those providers, then you have been bombarded with new acronyms for new programs and promises to remove older acronyms from your Medicare vocabulary. Medicare…more
| Health
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